A number of surgical procedures require instruments that are capable of applying a surgical fastener to tissue in order to form tissue connections or to secure objects to tissue. For example, during hernia repair it is often desirable to fasten a surgical mesh to the underlying body tissue. In laparoscopic procedures, such as for hernia repair, surgery is performed in the abdomen through a small incision, while in endoscopic procedures surgery is performed through narrow endoscopic tubes inserted through small incisions in the body. Laparoscopic and endoscopic procedures generally require long and narrow instruments capable of reaching deep within the body and configured to form a seal with the incision or tube through which they are inserted.
Currently, endoscopic techniques for hernia repair utilize fasteners, such as surgical staples or clips, to secure the mesh to the tissue thereby providing reinforcement of the repair and providing structure for the encouragement of tissue ingrowth. Another type of fastener suited for use in affixing mesh to tissue, during procedures such as hernia repair, is a coil fastener having a helically coiled body portion terminating in a tissue penetrating tip, in which the helical fastener is screwed into the mesh and body tissue. An example of this type of fastener is disclosed in U.S. Pat. No. 5,258,000 to Gianturco, assigned to Cook, Inc.
U.S. patent application Ser. No. 12/022,240 to Levin and Altman, the disclosure of which is incorporated herein by reference, describes a trigger-operated mechanical tacker for applying a rotary tack. The tacker includes a drive shaft coupled to a trigger. Operating the trigger causes rotation of the drive shaft. An articulated applicator arm is pivotally connected to the drive shaft at a pivot. The articulated applicator arm includes a rotatable output shaft connected to a magazine that holds rotary tacks. The magazine is located after (distal to) the pivot. A clutch mechanism, at initial movement of the trigger, has a first orientation that causes the articulated applicator arm to pivot about the pivot until reaching a stop, and has a second orientation wherein upon continued movement of the trigger, the clutch mechanism permits the drive shaft to rotate the output shaft and cause application of the rotary tacks from the magazine.
As mentioned above, in this device the magazine is distal to the pivot. It has been found that in many applications the length of the device distal to the pivot must be quite short, which severely limits the number of tacks which the magazine can hold.